Hi - telling my story since I'm feeling a little confused and down, and wanted to share.
Last year in 2023 I was diagnosed with high blood pressure (it's been a little high for past 20 years) but GP wanted to bring it down consistently so put onto Ramipril that did the job nicely.
It was early Jan this year when I noticed sharp pains in the centre sternum area of my chest. It seemed to coincide with eating and immediately suspected heart burn. My GP agreed, but just to put my mind at rest (I do worry) put me in touch with a cardialogist.
By the end of Jan, and meeting with the cardialogist, I was noticing this sharp pain/sensation only when walking uphill. If I'd not eaten for a few hours I could walk uphill no issues; walking uphill having just eaten was worst.
ECG was fine, Ultrasound fine but I was put forward for Angio CT Scan with contrast. At the same time I had calcium score and blood tests.
I was surprised/disappointed/ashamed to be told I have Single Vessel Coranary Artery Disease. It was clear on the scan there was some narrowing, although vessel branches had been formed around the narrowing to join the main branch further down - rather like a natural bypass. I also learned that my Calcium score was zero. My Cholesterol score was 4 last year and is now 3.5.
I'm now taking a couple of statins and asprin each day; the pain is not so sharp but not gone. I will give it more time.
I've been left feeling confused because despite good Cholesterol and Calcium score, I still have a narrowing artery. The cardialogist did mention I was not typical even used the phrase "unlucky", but it is what it is.
What I'm not understanding is being prescribed medicine to lower (and keep it low) colesterol when it's already a lot lower than those I know without heart issues.
Thanks for listening. Gav
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djparkie
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Not medical advice, opinions and suggestions only.
Strange, the CAC score is 0, so what is narrowing the artery, and was the CAC score derived from the CCTA with contrast, or from a CAC scan , they are not the same, the statins can only halt and slow the progression, so the pain is unlikely to go, but there is no CAC according to your CAC score.
Statins in combination with a strong anti-plaquing regime can begin to reverse a CAC score. The aspirin thinning the blood may reduce the pain, thinning the viscosity can increase the flow velocity in the vessel
Your case is highly unusual, and few cases exist in medical literature presenting in this way.
Okay, the better way is to derive the CAC score is from the CCTA scan, but they may have not had the software to do so, if you had LAP, which is a type of soft plaque (in theory) with little minerals present, you could have narrowing and CAC score of 0, however usually most people have a mix of plaque types, which occurs as they stratify over time, other ideas are, anatomical narrowing, or spasms in the artery? I would dig out your CCTA report, the answers will be in there, but it is still most unusual.
morning- I am the same! I had severe narrowing though in the LAD and had a stent fitted in 2023. They likewise didn’t seem very interested in figuring out why? (I’m also only 8.5 stone and cycle a lot).
But for me- I’ve only had the odd lunch time beer since I was forty. I can’t find it but am sure I had once read about physical differences - plaques occur at bends (like rivers!) and I do wonder - I have a sliding hiatus hernia (likely pregnancy related by also a past habit of having huge bowls of muesli and pot of tea and cycling up hills- I no longer do that), that the hernia could negatively affect an artery/plaque if it squeezes it? Hence increased angina after meals and excerise? I know doctors love to say heart burn is not angina but what if the same cause of heart burn can cause plaques and angina? I still have not managed to get docs to look at my hiatus hernia and my heart ‘together’- they don’t even care about the HH as it seems it’s expensive to check (I was diagnosed over 15 yrs ago, nothing since) and not a lot they can do- they say. I manage it through not having big meals and only drink well before a meal / just sip small.
Perhaps worth seeing if you have a hiatus hernia? And statins statistically stabilise plaques- hence taking them even with low cholesterol in the first place. Good luck!
Plaque does occur at bends, two reasons for this are, at the bends the blood flow is considered more turbulent, and the shear stresses increase against the endothelial layer,
As with the LAD it is wrapped around the Left ventricle which is expanding and contracting al the time, more than any other ventricle which can increase the forces at the bends and junction, leading to statistically higher chances of developing plaque there compared to other vessels, and especially for men.
Hi GavSo.e times you can be the fittest healthiest person, eating all the right things, not smoking, exercising regularly, and still develop heart issues!!!! Or you can be fairly unhealthy and never have a problem!! My heart issues were genetic and my cardiologist told me it was just bad luck!! It sounds like perhaps it's the same for you? I wish you well
Thanks for responding. One thing that's making me feel emotionally better is not feeling alone in this. My parents had healthy hearts, but grandparents had strokes so maybe missed a generation.
Statins seem to be prescribed whenever a person has heart disease. Apparently there are studies which show statin therapy stabilises plaques etc so it’s part of the protocol to prevent cardiac events. Cholesterol of 3 is good compared with folks who don’t have heart disease - but for folks who have heart disease, I’ve been told they want the number as low as possible - and an LDL of less than 1.8 (something like that).
As for why/how it happened - who knows? Sometimes I don’t even think the Drs know half the time.
I think this is what is grating on my emotions. I work in an industry where things go wrong and we take action to address but ALWAYS understand and take action (if required) on the root cause. Maybe I need to try harder and just accepting. 😊
Have you reviewed your CCTA report? It doesn't make any sense with a CAC score of 0, or at least not without further information. CAC is reversible is it just very difficult to do. There are a myriad of ways you can take action.
Will ask my consultant for the CCTA report. I have a letter that reports that on the Left side everything is normal but on my dominant right coranary artery "there is along segment of diffuse non calcified plaque from mid distal vessel into the ostia of the PDA and PLV branches, causing total chronic occlusion, with a suggestion of collateralisation of the distal vessel". Wish that meant something to me.
Not medical advice , suggestions and opinions only, ok it makes sense now, and it means something to me, it is fresh plaque that hasn't yet calcified. So the minerals are not present, to absorb the x rays on a CAC scan, still unusual.
Some good things to take away.
1. It's better to have it in the RCA than the LAD.
2. You have already developed collaterals, keep doing whatever you are doing as its developing collaterals.
3. The plaque is fresh and is more likely to respond, to intensive cholesterol therapy, think statin + ezetimibe, or ezetimibe plus PCSK 9 inhibitors, you will also need a strong anti plaquing therapy.
4. In time you will be able to discuss your options with the surgeons as its only one vessel you would be an excellent candidate for a stent or CABG. However this depends on the junctions and your anatomy for the final decision, But usually young people with one vessel do very well with such surgical treatments.
5. Proximal means closer to the main arteries. Distal means at the further end when its coming to the end of being a coronary artery and separating off into smaller vessels.
I am in a similar situation. I was completely healthy, always had nice low BP and low cholesterol. Then I had a heart attack and angiogram showed coronary artery narrowing and a blockage. I didn’t understand either, but I think there's a lot of people who don't fit the 'usual' mold. The drs just said it happens sometimes, I was unlucky. So whatever my cholesterol was before, it was too high for me. (even though it would normally be considered a good level) Hence I am now on all the usual heart meds - statin to make my already low cholesterol even lower, BP meds to make my already low BP even lower & blood thinners.
Everyone's body is different I guess, so I suppose my body just isn't good at handling even 'normal' cholesterol, so now it needs to be extra super low!
Thanks for your response and yes the word "unlucky" keeps cropping up. I guess I had stereotypical images of those swigging beer, smoking and overweight having heart disease. I have been very lucky for the first 50 years of life, never seeing the inside of a hospital. It just feels the last couple of years I'm getting on first name terms with far too many consultants😀 - last year I was apparently "unlucky" to need my gallbladder removing. Oh well, keep kicking. 💪
Firstly, I would agree that it is disappointing news to say the least, but dont be ashamed. It is just bad luck.
For me, I am younger than <50, have already stenosis of the LAD. guess what - have an identical twin brother, similar lifestyle weight - he has no CVD. It just shows you that luck plays a part and you cant always fully control everything. Whilst I am disappointed and shocked, I do see it now as a blessing to have been diagnosed out of the blue with CVD because I can start the journey to limit the risk factors as much as possible by taking the required medicine and living a healthier life. Some people dont have that luxury and only find out when it is too late.
Hi we are all individual and present differently. Despite my ecg being majority normal, 1 week holter normalish my blood tests and blood pressure normal. Angioplasty found absolutely nothing. But in reality on echocadiogram my heart function was down to 20 - 25 severe Heart Failure. Do I feel confused all the time when I go to a and e they do blood test, blood pressure etc I keep telling them my heart defect only shows on echocadiogram. They then informed me A and E is limited on tests they can perform. Because all stats are normal in there eyes they discharge me. To behonest I just give up and suffer in silence.
Yes I am now on optimised Heart Failure meds they were discharging me to community HF team but nothing when I called to chase up I was spoken to so rudely by the hospital reception I said can you check referral, her response I do not access medical records, so can I leave message for nurse no there too busy. So basically I have been abandoned
Okay if you make a new post with the information you just told me there are a lot of people who can make suggestions for that, I believe the first one would be contacting PALS at the hospital. I think it's definitely worth making a new post about your situation. I think people could give you some good advice, maybe title it something like "Need help with dealing with the hospital, can't get the right heart failure treatment."
If your narrowed coronary artery,which is causing angina symptoms, is caused by soft, noncalcified plaque build up, your coronary calcium score could be zero. Also,there are anatomic anomalies of coronary arteries that cause disturbances in blood flow that can damage the lining of the vessel leading to plaque build up regardless of total cholesterol,HDL & LDL levels.Also,exertion after a meal is more demanding on the coronary circulation as the digestive process sends blood into the intestinal tract circulation and away from our muscles,including the heart. Wait an hour or two after a meal before any exertion.
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